Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharmacology > Week 1: Anticoagulation > Flashcards

Week 1: Anticoagulation Flashcards

1
Q

Coag factors are _____

A

enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where are coagulation factors made?

A

the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does the final pathway result in? (2)

A

conversion of prothrombin (II) to thrombin

catalyzes the conversion of fibrinogen to fibrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does fibrin activate in the fibrinolytic system?

A

plasmin

tissue plasminogen activator (t-PA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Balance is maintained by homeostasis of what? (2)

A

procoagulants (coag factors)

endogenous anticoagulants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the endogenous anticoagulant that is important for warfarin dosing?

A

Proteins C &S

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the endogenous anticoagulant important for heparin dosing?

A

Antithrombin III

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The fibrinolytic system degrades _____.

A

fibrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the result of the fibrinolytic system? (3)

A

Fibrin split products (FSP)
AKA: Fibrin degregation products (FDPs)
Fibrin Dimers (D-Dimers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Increased levels of the fibrinolytic system, suggest what?

A

presence of thrombi (think DVT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are consequences of venous thrombi? (5)

A 
DVT 
"Red Thrombus"
AKA: "Venous Stasis" thrombi
VTE (Venous thromboembolism)
Complication= Pulmonary embolus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the consequences of arterial thrombi? (3)

A

platelet driven
“white thrombus”
complication= stroke, MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the risk factors of a partial thrombosis?

A 
surgery
cancer
immobility
varicose veins
pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a potential complication of anticoagulation agents?

A

Bleeding

NOT allergy! extension of their MOA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is heparin’s mechanism of action?

A

heparin binds to antithrombin III (ATIII)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Heparin requires the binding of what for its MOA?

A

binding requires specific pentasaccharide sequence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is heparins limitation?

A

The heparin AT complex inhibits only soluble thrombin not fibrin-bound thrombin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a heterogenous mix of sulfated glycosaminoglycans?

A

unfractionated heparin (UFH)-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What percent of UFH molecules have the pentasaccharide?

A

1/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

UFH is only effective on _____ _____.

A

soluble fibrin not clot-bound fibrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

UFH prevents the growth/propagation of what?

A

the thrombus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

UFH allows the _____ ___ to degrade the clot.

A

fibrinolytic system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is UFH measured?

A

measured by the activated partial thromboplastin time (aPTT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is used for DVT prophylaxis- SubQ Heparin?

A

UFH

5,000 units SubQ every 12 hours or every 8 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is a risk of IV UFH?
risk of HIT
26
What are the advantages of UFH? (6)
``` immediate anticoagulation measured by aPTT effects reversed by protamine prevents propagation of clot may be given subQ for prophylaxis Usually done by pharmacy dosing service ```
27
What are the disadvantages of UFH? (5)
``` Non-linear kinetics frequent lab tests required Increased risk of bleeding Potential for life threatening immune mediated thrombocytopenia (HIT) minimal effect on interior of clot ```
28
When is protamine sulfate used? What is its MOA?
used to reverse UFH | combines with strongly acidic heparin
29
What are the 2 types of HIT?
HIT (I) non immune | HIT (II) Immune
30
What is significant about HIT I (non-immune)?
OK 10% of patients transient due to clumping of platelets (artifact) happens immediately
31
What is significant about HIT-II (immune)?
``` very bad < 3% of patients seen after 5-10 days of heparin Platelet count falls by >50% immune mediated by anti-platelet factor 4 (test for PF4) ```
32
What is significant about low molecular weight heparin?
more favorable benefit/risk ratio more predictable dose response ratio weight based dosing less risk of HIT (if started initially)
33
How is fractionated (low MW) heparin administered?
Sub Q
34
What is a example of a LMWH?
enoxaparin (Lovenox)
35
What are the indications for LMWH? (4)
ACS treatment DVT PE VTE prophylaxis in high risk populations
36
What is the dose of enoxaparin (lovenox) for acute DVT with or without PE INPATIENT?
1mg/kg/dose subQ every 12 hours or 1.5 mg/kg subQ daily
37
What is the dose of enoxaparin (lovenox) for acute DVT with our without PE OUTPATIENT?
1mg/kg/dose subQ every 12 hours
38
What is an example of a vitamin K antagonist?
warfarin
39
What is the MOA of warfarin?
inhibits post-translational carboxylation of coagulation factors II (prothrombin), VII, IX & X inhibits two vitamin K sensitive synthetic enzymes
40
How is warfarin reversed?
pharmacological doses of vit K (phytonadione;Mephyton)
41
What are the doses of vit K (phytonadione;Mephyton) to reverse warfarin?
2.5-10mg po (5mg tablet) | 1-10mg IVPB (rare risk of anaphylaxis with rapid infusion)
42
Warfarin is often started with ______, which is Dcd when warfarin is therapeutic?
Heparin
43
How long does it take for full anticoagulation with warfarin?
5-7 days
44
How can you measure the effects of warfarin?
PT & INR
45
What is the therapeutic ranges of INR for AFIB, DVT and PE when on warfarin?
2-3
46
What is the therapeutic range with mechanical heart valve when on warfarin?
2.5-3.5
47
How long does it take for each dose of warfarin to take effect?
48 hours
48
What is a complication of starting 10mg daily of warfarin?
warfarin-induced skin necrosis
49
Drugs that inhibit ____ increase INR and increase ______.
CYP2C9;risk of bleeding
50
Drugs that induce CYP2C9, ______ INR and ____ risk of thrombosis
decrease INR | INCREASE the risk of thrombosis
51
What is an example of a medication that inhibits CYP2C9?
bactrim and flagyl
52
What is an example of a mediation that induces CYP2C9?
contraceptives (estrogens/progestins)
53
What are sources of high dietary folate?
beef, pork liver green tea leafy green vegetables spinach
54
What is a synthetic pentasaccharide that is mainly renally eliminated?
anti-factor Xa inhibitors
55
When are anti-factor Xa inhibitors contraindicated?
CrCl <30
56
What is the unlabeled use of anti-factor Xa inhibitors ?
DVT patients with h/o HIT
57
What is an example of anti-factor Xa inhibitors?
fondaparinux (Atristra) profiled syringes
58
What is an oral direct Xa inhibitor?
Xarelto (rivaoxaban)
59
What is a benefit of xarelto (rivaroxaban)?
no lab monitoring
60
What is the recent reversal agent of xarelto (rivaroxaban)??
Aadexant alfa
61
What is the most common adverse effect of xarelto (rivaroxaban)?
bleeding | ">5%"
62
What are the types of direct thrombin inhibitors (DTIs)?
bivalent and univalent
63
What are examples of bivalent DTIs? (3)
lepirudin (refludan) bivalrudin (angiomax) desirudin (iprivask)
64
What are examples of univalent DTIs?
Argatroban | Dabigatran (pradaxa)
65
What is significant about DTIs?
may be used in patients with h/o HIT II
66
What DTI is given in patients with HIT and poor renal function (not really eliminated), can be given IV and monitored with PTT?
Argatroban
67
What DTI was withdrawn in AC in 2006, many patients developed hepatotoxicity after stopping the drug?
Ximelagatran (Exanta)
68
What was the second oral DTI that requires no lab testing and has a new reversal agent (2015)?
Dabigatran etexilate (pradaxa)
69
What is the Dabigatran etexilate (pradaxa) reversal agent?
Idarucizumab (Praxbind)
70
What medication is a humanized monoclonal antibody that binds to Pradaxa and its acylglucuronide metabolites?
Idarucizumab (Praxbind)
71
What is the dosage of Idarucizumab (Praxbind)?
two consecutive 2.5 gram doses IV | $3,500 for 5 gram dose
72
What medication is a factor Xa inhibitor reversal agent?
Aadexant alfa
73
What medication is a decoy protein that corrects apixaban, rivaroxaban, edoxaban, enoxaparin or fondaparinux?
Aadexant alfa
74
What are types of anti platelet drugs?
glycoprotein IIb/IIIa Inhibitors | ADP receptor antagonists
75
What medication is a glycoprotein IIb/IIIa Inhibitors that can be administered IV :ACS or PCI and or stent?
eptifibatide (integrilin)
76
What medication is a monoclonal antibody (human/murine) that has numerous sin effects and therefore minimally used?
abciximab (RepPro)
77
What is the blackbox warning of Ticlopidine?
neutropenia agranulocytosis thrombotic thrombocytopenia purpura aplastic anemia
78
When is Ticlopidine (Ticlic) used?
reserved for patients intolerant to aspirin or those who failed aspirin therapy
79
What is a prodrug converted to unidentified active metabolite that ultimately prevents platelet aggregation?
clopidogrel (plavix)
80
What is the drug interaction with clopidogrel (plavix)?
decreased activity with PPIs via CYP2C19 inhibition | increased risk of restenosis while on PPIs
81
What antiplatlet medication is more effective than clopidogrel or ticlopidine and has less inhibition by PPIs ?
Prasugrel (Efient)
82
What is a platelet antagonist that inhibits platelet aggregation by acetylation of ADP receptor that lasts the life of the platelet?
Aspirin
83
What are the adverse effects of asa that are weighted against the benefits?
GI bleed and tinitis | minimal at low doses
84
What is the MOA of dipyridamole (persantine)?
platelet aggregation inhibit and vasodilator
85
When is dipyridamole (persantine) used?
with warfarin in patients with mechanical heart valved (rare) Diagnostic agent in CAD (persantine stress test)
86
What is an example of a tissue plasminogen activators (TPA)?
Alteplase (activase, cathflo)
87
When is Alteplase (activase, cathflo) used?
lysis of coronary artery thrombi in AMI (less common) management of ischemic stoke (more common) lysis of occluded ports and catheters
88
What is the stroke dose of Alteplase (activase, cathflo)?
load: 0.09 mg/kg over 1 minute (10% of total) | Followed by: 0.81 mg/kg CIV over 1 hour (90%)

Pharmacology (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions